Tag Archive | kaurina danu

I am absolutely ecstatic to announce that I had my fourth kid, and 2nd daughter in January 2015. She was welcomed into the world by her older brothers and sister with so much love.

Of course as a doula and prenatal teacher, I was very interested in putting all the skills I teach in my classes to good use in my own labour.

First of all, right from the beginning of my pregnancy, I wanted to choose the best health care provider that would be a good fit with my birth preferences. This is one of the most important things I tell my clients that will affect the kind of birth you have. Don’t just choose any random maternity care provider. Find the ones who best fit with the kind of person you are, and the kind of birth you want.

Secondly, birth can be unpredictable, so when things don’t follow the textbook version of labour, you have to make informed decisions regarding what to do. There are ALWAYS options. When my water broke and my labour didn’t start for over 24 hours, it was stressful because, of course, as a mom, you naturally worry. But I kept reviewing my options and the potential risks of all the options available and kept discussing things with my midwives. Just to be clear, I felt totally fine with having any medical intervention that was clearly necessary and helpful, but I also know when interventions are not entirely necessary. There are always risks to both sides – having a medical intervention or declining it. In my situation I had the options of going to the hospital to start an induction, using non-medical ways of starting labour (herbs/ acupuncture etc which can be highly effective), or simply waiting it out. That’s another reason moms love having a doula with them in pregnancy and labour – if unexpected situations arrive, the doula can often talk moms through the decision making process, empowering them with a range of information on options so that moms can make an informed choice and feel good about it.

I knew the risks and possible outcomes of all scenarios and decided to take various herbs to get labour started. I also know that emotions and ’emotional blockages’ can have a huge impact on labour. So with the help of my doula friend, I worked through any deep seated emotions I was having that could have been blocking my labour from starting. That was EXTREMELY helpful because after I realized a huge emotional block I was holding, and then let it go, my labour started soon after.

Thirdly, of course, is all the pain coping strategies I teach. Once labour started, the first half was the easy part. The key for that is to keep focussing on staying completely relaxed. Holding on to any tension or resistance will cause pain. I was able to feel no pain at all for the first half of the labour by breathing out all the pressure waves and making a low toning sound. You can try it now, just let yourself sigh with a deep sound. You naturally let all your tension go and you feel more grounded. Remember fear in labour = adrenaline = pain = more fear = more pain. You have to keep the adrenaline out of the equation in labour and keep deep breathing away any tension or pressure you feel building up. Pay attention to your body.

As contractions intensified, I moved around, feeling for whatever positions felt more comfortable. Sitting, squating, standing, lunging, leaning forward on furniture, sitting backwards on the couch, swaying my hips etc. I was chatting with my doula, friend, mom, and midwives in between contractions. Eventually, I felt like leaving the living room and going up to my bedroom. In labour, women naturally experience a going within. They feel like they are going deeper and deeper inside themselves as labour progresses. A woman starts using more of her primitive, instinctual brain and less of the cerebral cortex. It is the instinctual part of the brain which controls the natural process of labour. Labour flows more smoothly when a woman is undisturbed so she can smoothly go deep within herself. Any distractions that pull a woman out of this state of mind will slow down the labour and also create unnecessary pain sensations. Bright lights, too much talking, asking questions, talking about time (which is a cerebral concept), telling a woman what to do so she can’t listen to her own body’s instincts, disturbances like frequent blood pressure checks, vaginal exams etc. will all take a woman away from her “labour land” state of mind. And to the labouring woman, this feels quite irritating.

I told my midwives that I wanted a very hands off approach to my birth. I didn’t want any unnecessary disturbances such as internal dilation checks or them telling me what to do. But having them there in the background helped me feel safe in the rare situation where medical help might be needed. It is important for birthing moms to feel safe and supported. That will lead to a smooth labour process. Anything that makes them feel worry, fear or anxiety will cause a slowing down of the labour process, or even complications.

Once I got to my bedroom, the lights were off with just a dim light on in the bathroom. My older daughter had woken up by this point and she lit some candles to add to the mood of the room. My mom made sure the music playlist I had put together for the birth was still playing. I had complied a series of songs that I found both inspiring and relaxing. I love music and I find it helps me set the tone for focusing on feeling good. In labour, you want to take your attention off the pain sensations and replace them with anything that makes you feel good. My doula was massaging my sacrum while holding a hot pack on my lower back. My husband rubbed my back and shoulders. That all felt really good. By this point, I was not feeling zero pain, like in the earlier part of the labour, but all these things helped take the edge off the intensity of contractions so they were completely manageable.

People often tell me that I’m brave to have a homebirth. Nothing could be further from the truth. The truth is, in terms of pain management, homebirth is often easier to manage because I feel more comfortable at home and there are so much fewer disturbances to my instinctual state of being. In terms of safety, solid evidence shows that homebirth is as safe, if not safer, than hospital birth, as long as it’s a healthy pregnancy, there are trained care providers in attendance, and a hospital is less than an hour’s drive away if there is a need to transfer. Here in the lower mainland, BC, Canada, we are so lucky to have a fantastic midwifery system that functions relatively smoothly at home or hospital. If you feel more comfortable having a homebirth, definitely go for it, or at least look into it. If you feel safer and more comfortable in a hospital, then hospital is the place for you. Birthing moms should be in the place that is more conducive to them feeling safe and supported. You have to know yourself, and know what you prefer. It doesn’t matter what anybody else does. It only matters what kind of experience you want and how you’re going to get it.

Eventually, my contractions got pretty strong and I wondered if getting in the bathtub with warm water would help. I wasn’t particularly planning a waterbirth, but I always keep my options open. The warm water does take the edge of, but of course, labour is still a pretty intense and powerful process. At one point I joked with my midwife, “So you brought an epidural with you, didn’t you?”

“Yeah, it’s just in my back pocket,” she smiled.

“Oh good. I wouldn’t want to be crazy enough to have a natural birth.” 🙂

(Just in case you didn’t know, you can’t have an epidural or any other drugs at a homebirth because of the risk those things entail.)

I remember, through one contraction I just swore the whole way. Then for the next one I struggled to remember what the purpose of all the pain was. Oh yeah, to open the cervix and let the baby out. So I started chanting “Open, open…” through the whole contraction, while visualizing my cervix opening fully, quickly and easily. Soon after that I started to feel worried. I had the presence of mind to remind myself that this was a normal emotion during transition (the last bit of the dilation phase before the pushing phase). I was worried that this would go on forever and the baby would never come out. It’s common to have this rush of irrational feelings in transition, and a doula often reassures a labouring mom that this is a natural part of the process and it’s good sign that means things are progressing. It is important for the mom to go back to her state of feeling safe and relaxed instead of letting the worry and the adrenaline intensify. Again, smooth, fast and instinctual pushing phase vs. prolonged and worried pushing.

I soon began to feel “pushy”, meaning I felt like pushing a little at the peak of each contraction. I let the midwives know so they could get ready and everyone else too. My younger two kids were woken up so they could be present for the birth. I tried different positions in the tub – on my back, side, hands and knees, until I found the most comfortable position for myself, which just happened to be squatting facing the width of the tub instead of lengthwise so my feet could push against the side while my back rested on the other side.

Pushing contractions feel different than dilation contractions because you’re not just trying to relax through each one. You’re actually actively pushing with each one. And in a drug free birth, you can feel the powerful force of your body pushing instinctively. It’s not something you can stop. It’s like one mom said, it feels like you’re body is just vomiting the baby out. It’s so strong and so involuntary. In a drug free birth, no one has to tell the mom how to push. Her body just does it. Pushing feels way more fun than the dilation phase before it. I felt very powerful.

Once the baby’s head was low enough in my pelvis, I could feel it. It was definitely a strange sensation and I exclaimed to all the 10 people who, by now had piled into my bathroom, “It feels like a bowling ball.” I put my finger in and felt the top of the baby’s head less than an inch away. A couple more pushes later and I could feel her head crowning. This feels like a burning sensation as the perineum stretches around the baby’s head. I expected this part to take a while, as it can take several pushes to slowly push the head out. But my body just kept going and in one push she went from completely inside to completely out. I had planned to catch her myself if possible, but she came so fast. No one was quite ready for that. Luckily my husband was speedy quick in catching her and lifting her out of the water and onto my tummy. She was happy and content sitting on my tummy, looking around.

We hadn’t found out the gender, so it was very exciting to look down and see it was a girl. My daughter finally got the sister she had been hoping for for so long. Here’s the picture that captures the sheer intensity of emotions of that moment right after birth – relief that it’s over, exuberance over the new person you are meeting, and for me the shock of how fast she came out and surprise that I got the girl I wanted.

It was a lovely family experience to have all my kids there, my mom, sister-in-law and friend. My husband caught the baby, my daughter took the photos, my older son cut the cord and my younger son helped the midwife weigh the baby. My kids will all grow up knowing that birth is just a normal, natural and safe part of life. Not something to fear. By the way, I wanted to wait till after the placenta was out to cut the cord, or at least until the blood in the placenta had finished pumping to the baby, instead of cutting the cord immediately. This is so that she can get her full blood volume and have a gentle transition to life on the outside.

Once I got out of the tub and walked back to my bed, I birthed the placenta and breastfed my baby before letting everyone else have her for some cuddles. My mom made me a nutritious, yummy smoothie with a tiny piece of placenta blended in. Having a bit of placenta reduces the risk of postpartum hemorrhage.

It was a lovely morning. I stayed in bed all day snuggling my new sweetheart. And the other kids were just over the moon excited with their tiny sister. Plus they got to take a day off school. 🙂

Being a Doula

It’s intense. I get to witness such a wide range of human emotions, from fear and desperation, to inner strength and triumph, to extreme joy and jubilation. I get to be there through a woman’s most challenging and vulnerable moments and watch the expressions on her face on her journey to discovering inner strength she never knew she had. I get to revel in the wonder that quietly surrounds every newborn person that comes into this world – that tingly awe of a natural and unexplainable meditation that comes over you when you allow yourself to feel what a newborn feels.

The world of birth is so far removed – emotionally and mentally, from daily life, it always takes me many hours to readjust to mundane existence after I return home from a birth. I always feel as if the tremendous journey of every birth should make headline news, but it stays largely unknown to the public, summarized into the petty details of gender and weight of the baby. I feel so humbled and privileged to be witness to one of the most special human events which remains so unknown to the general public. And because, as a doula I am not responsible for doing anything medical or charting or watching monitors, and I am there for each mother throughout her labour and birth no matter how long it takes, I am right there with her feeling it with her. Well, not really – a little less pain, just all the emotions. Every birth is different and unique and every birth moves me and changes me. Every birth teaches me a little more about myself, about women, about babies, about human beings and about the wonder of life.

Most of all, I love being a Doula because every birth has such special memories for me as well as for the parents. Just like weddings can hold such special memories for people, so too can their children’s births. I will always have a special place in my heart for each set of parents whose birth I have been to. My hope is that I have helped make the experience be filled with more positive memories and resolved the stressful ones. I try to highlight the awesomeness of each mom and dad and baby so that they will start this important journey of parenthood feeling good about themselves.

When I think back over all the births I’ve been to, some stand out because of the difficulty the mom went through but overcame triumphantly, some stand out because of the funny comments made by either the mom or dad (tactful humour in the delivery room always helps to lighten the mood), and some stand out because of the great love that existed between the mom and dad and baby. Wouldn’t it be nice if that’s what made headline news in the world. Not wars and crimes. This is what humanity is made of. And I am grateful to be a part of it.

Thank you to all the couples who have allowed me to be present for this very special time.

With my clients, I always get them to think about things critically. I explain the difference between evidence-based practice in medicine and non-evidence based practice. While most people would assume that ALL medical practice is evidence-based, in reality this is not practical. It is impossible for everything to be evidence based simply because new evidence is being generated on a daily basis. Sometimes research can be contradictory, or new evidence can refute old practices that have been the standard practice for decades. It is difficult for medical professionals to be always changing the way they practice to keep up with all the new research. Also, what works for some people with certain conditions may not work with other people who have variations of the condition, or compounding factors. The reason I have taken the time to explain all this is because the research on bedrest may surprise you.

The assumption is that while bedrest may be uncomfortable, inconvenient, cause muscle atrophy and make moms-to-be bored out of their minds, it is all worth it as along as it helps prevent preterm labour and reduce health problems for the baby. Any pregnant mom would be willing to do whatever it takes to have better health for her baby. I was pretty shocked, to say the least, when I examined the evidence around pregnancy bedrest, that the research doesn’t quite support the common assumption.

Surprisingly, not very much research has been done on the risks vs benefits of bedrest in pregnancy. Of the studies done, they showed that bedrest either did not improve outcomes, or it caused worse outcomes.

Research on Bedrest in Pregnancy

”Some benefits may be there, but they haven’t been documented,” said Dr. Judith A. Maloni of the Bolton School of Nursing at Case Western Reserve University, who just completed a $1.7 million study of bed rest supported by the National Institutes of Health. In fact, as Dr. Maloni’s study showed, there is good evidence that bed rest in pregnancy can cause harm, resulting in more than a dozen consequences, including babies who are smaller than normal and mothers who are too weak and tired to care for them. Their babies also tended to weigh less than normal, perhaps because there were fewer blood cells to carry oxygen and nutrients to the womb.

Dr. Robert L. Goldenberg, an expert in maternal-fetal medicine at the University of Alabama at Birmingham, said in an interview: ”Most obstetricians believe bed rest will reduce the risk of preterm births and other pregnancy complications like preeclampsia, incompetent cervix and intrauterine growth retardation. But the data are mostly nonexistent.

Dr. Goldenberg noted, for example, that in two of four clinical trials of preventive bed rest in twin pregnancies, the women randomly assigned to hospital bed rest experienced a greater rate of preterm births than those who weren’t. The other two studies showed no difference.

So why do doctors persist in prescribing bed rest, not only when prematurity threatens but often preventatively, especially in pregnancies involving two or more babies? In Dr. Goldenberg’s view, ”physicians don’t have any real tools to prevent preterm birth, but they want to do something so they choose one they think is innocuous.”

After giving birth, many of the women found themselves so out of shape that they had trouble getting out of a car or using their legs to stand up, and they were so fatigued that their ability to care for their newborns was compromised.

Dr. Maloni suggested that after childbirth, women who have been on bed rest should undergo cardiovascular and physical assessments and receive a rehabilitation program.

Physical problems aside, women who have endured enforced bed rest describe themselves as bored, frustrated, depressed, irritable, guilty and scared. Many mention increased family and spousal tensions and angry young children at home. Fathers, meanwhile, have to take over all the household responsibilities while continuing to work and wait on their wives or visit them.

The economic burdens can be great, as well, especially if the women have jobs that they can’t perform in bed and young children who need care. One study estimated the cost of bed rest per woman at $1,400.So why do so many women follow prescriptions of bed rest? Mostly because they are afraid not to. As Kris explained: ”I was told that there were no concrete studies. But fear plays a big part. You’ve got to play it conservatively. After all, it’s not just about you. It’s about one or more other beings. You have to rely a lot on the experience of your providers who believe that if a woman is put on bed rest, the pregnancy will last a little longer.”

Research indicates, that bed-rest treatment is ineffective for preventing preterm birth and fetal growth restriction, and for increasing gestational age at birth and infant birthweight. Studies of women treated with pregnancy bed-rest identify numerous side effects, including muscle atrophy, bone loss, weight loss, decreased infant birthweight in singleton gestations and gestational age at birth, and psychosocial problems. Antepartum bed-rest treatment should be discontinued until evidence of effectiveness is found.

They went on to cite evidence that exercise actually improved outcomes

Sedentary pregnant women were compared with those who participated in more than one type of leisure sports activity [22]. Active women had a significantly reduced risk of preterm birth. Women who engaged in light physical activity (walking) has a 24% reduced risk of preterm delivery and women who engaged in moderate to heavy activity (sports such as tennis, swimming or weekly running, to competitive sports several times a week) had a 66% reduced risk. The greater the intensity of the activity, the greater the reduced risk of preterm birth.

Every major organ system is rapidly affected by reduced hydrostatic gradients, and reduced loading and disuse of weight-bearing tissues during bed rest.

The American College of Obstetricians and Gynecologists has concluded that bedrest does “not appear to improve the rate of preterm birth and should not be routinely recommended.”

The bottom line is that more good scientific studies are desperately needed. In the meantime, caregivers disagree on when and how to prescribe bedrest. Some say that until there’s good evidence to the contrary, bedrest is worth a try. Others argue that bedrest itself can have a variety of negative effects and that women should not be subjected to it until we know that it does more good than harm.

These caregivers tend to believe that the use of complete bedrest should be curtailed, and that some women would be better off just taking it easy.That means restricting their activity level, cutting back on work, avoiding heavy lifting and prolonged standing, and resting for a few hours each day, for example.

If you’re going to be on prolonged bedrest, you may want to line up additional professional support. Ask your practitioner for a referral to a physical or occupational therapist, who can teach you simple exercises to do in bed to improve your circulation and maintain some muscle tone. The therapist may be able to suggest ways to reposition yourself in bed so that you’re more comfortable.

You may also benefit from counseling, since you’re likely to feel torn between your obligation to your unborn child and to your family or job. Counseling can be helpful for your partner as well if your bedrest is putting a strain on your relationship.

Why is bedrest still being recommended?

Why is bed rest still recommended despite the recent evidence that it does not prevent preterm labour? Bed rest for pregnancy problems has been a common recommendation since the early 1900’s, so it has been around a long time. If there are risks that are associated with preterm birth, most expecting mothers would expect their doctor to do be able to do something about it, and they expect bedrest to be one of those things. If a doctor went against the norm and didn’t recommend bedrest, the mom-to-be would likely find him/her to be negligent of proper care.

Furthermore, it makes logical sense that bedrest would decrease the stress put on the cervix and uterus or other systems in the body and so reduce the chance of preterm birth. It could be possible that some amount of rest, destressing and lying down could be very beneficial to high risk pregnancies.

Making sense of the situation

While it seems logical that rest and lying down may have some benefits, extreme amount of inactivity seems to be related to more problems than solutions. It is also logical that if mom’s circulation is severely compromised by long periods of inactivity, this will lead to poor circulation to baby. Also, because mom’s muscles atrophy with long periods of inactivity, she is less likely to be able to look after her newborn normally, and is less likely to have the stamina to do the hard work of labour.

In some situations where mom is doing a lot of strenuous or stressful activity in her job or daily life, having the recommendation for bedrest can be a relief. In those situations bedrest may be fantastic.

Despite the current evidence, if I were a mom who was at risk for preterm birth, I may still feel the need to avoid too much activity or be upright for long periods in the day, but at the same time, make sure I did appropriate exercises to maintain muscle strength and circulation.

This is just general information. Every mom needs to discuss her unique concerns and situation with her doctor or midwife in order to come up with a plan that she can feel comfortable with.

Resources for bedrest

Isometric Exercises

Isometric exercises focus on tightening and relaxing a muscle group, and prove helpful as a way to prepare for relaxation during labor. To carry out this type of exercise, a woman can focus on each and every muscle group beginning at her feet. Perform this exercise by clenching muscles for a brief period, such as a count of three, and then releasing them. She can squeeze a stress ball to help with hand and arm stiffness. The American Pregnancy Association also suggests simply pressing the hands and feet against the bed as a way to engage multiple muscle groups.

Core Exercises

Tightening the abdominal muscles and releasing them can help maintain some of the woman’s core strength. While sit ups and crunches may not be recommended or allowed by a doctor, a static exercise may prove sufficient. Any abdominal muscle engagement should only be done with the permission of a doctor. The health care provider may even recommend carrying these exercises out only with supervision. Static means the body remains in a position, such as reaching out from the chest at a 45 degree angle while lifting the back off the bed. Just a slight bit of resistance can help improve the abdominal strength. Squeezing and releasing the buttock muscles can help build and remain muscle tone in the core areas as well.

Back Rest

Back aches occur frequently during pregnancy. To take some of the pressure off the back, a simple arch and relax exercise can prove helpful. To do this, the woman must lie flat and slightly arch her back for a count of three. She can then rest out flat for a count of three before repeating. Lying flat for more than a few seconds is not recommended, as it can cut off the blood circulation during pregnancy. While resting or sleeping, reduce back pain by using pillows to take the weight off the muscles.

– Kegels

– Pelivc Tilts

– Back and Abdominal Strengthening

4. Here’s a video for Bedrest Exercises at a website called Educated Pregnancy with Dr Cathy. She’s got tons of other pregnancy videos on there as well.

5. And lastly, Mamas On Bedrest is a website that offers a DVD that is specific to bedrest in pregnancy. Here’s some of what the website says :

Until now there was no readily available, effective exercise program a woman could do while on bedrest. Bedrest Fitness, an exercise DVD, gives women the skills and guidance they need to safely exercise while on bedrest. Without regular exercise, a pregnant woman on bedrest is at increased risk for:

Blood clots in her legs that can lead to strokes, heart attacks or pulmonary embolisms.

“Failure to progress” during labor resulting in cesarean section delivery.

She is less able to care for herself and her new baby post partum and requires additional time to recover from her pregnancy and birth experience.

The Bedrest Fitness exercise program is designed and performed by Darline Turner-Lee, a nationally certified physician assistant, an American College of Sports Medicine Exercise Specialist® and certified perinatal fitness instructor. The exercise DVD takes women through a series of gentle yet effective movements and also offers a brief lecture on bedrest. Women who regularly perform the exercises while on bedrest can expect the following health benefits:

Maintenance of muscle tone and physical strength

Improved circulation

Reduction in the risk of leg clots leading to strokes, heart attacks and pulmonary embolisms

Increased endurance during labor

More effective pushes during delivery

Decreased recovery time post partum

The emotional assurance that she is doing something great for herself and her baby

The exercise program adheres to the guidelines set forth by the American College of Obstetricians and Gynecologists for exercise during pregnancy and uses pillows for support and rubber exercise bands for resistance. A rubber resistance band comes with the exercise DVD.

So I hope you have found this information useful. I hope you realise that you don’t have to feel like the situation is out of your control if bedrest has been recommended. Complete bedrest for weeks at a time is not as useful as was previously thought, so a balanced approach seems to be more beneficial. You still have a lot of choices that you can make, and figure out how to balance resting and destressing with strategic activities for muscle strength and circulation, and still live life as normally as possible.

Have fun, and let me know about your experience in the comments below!

The Prenatal Classes are all set and ready for expecting parents in the Langley, Surrey area. Evening classes for first-time parents will begin Tuesday October 25th 2011 in Willoughby, Langley.

Classes promise to be pretty exciting and extremely useful for parents preparing for birth and new parenthood who want to understand how to have a positive experience. A lot of people have told me they’re not sure if they should take prenatal classes because they’re not sure if they will really be useful. The media has done a good job of portraying prenatal classes as a place where round crabby women learn to breathe while saying, “hoo-hoo hee-hee.” I assure you there’s a lot more to preparing for birth and parenthood than hoo-hoo heeing. Actually hooing and heeing is not even in our syllabus.

Our classes at The Prenatal Journey are not simply a biology class either. Memorizing a bunch of facts is NOT going to help you get through labor. In fact, that will most likely stress parents-to-be out more and undermine their confidence in their own abilities.Our classes are hands-on, interactive and totally enlightening. We have never had any clients say they didn’t learn so much that was actually useful. Clients always feel that all their questions are answered, and their fears transformed into confidence.

“You didn’t just teach us what to EXPECT when expecting. You taught us what to DO!”

– Jenny and Tom, Surrey, BC.Comparing their experience in the Refresher Class for second pregnancy to previous experience in other prenatal class with first pregnancy.

You can go to Prenatal Classes for info about classes and prenatal course content.

Now is the perfect time to register for classes. Because this is the first time Kaurina Danu and Jamie Taylor are collaborating, we’re offering our Introductory price of $165 for First-time Parent evening and weekend classes, and $100 for Refresher classes. This price won’t last long. Most expecting couples attend classes in their last trimester, but even if you’re in your first or second trimester, you can place a deposit now for future classes to get the introductory price.

I’ve also had a lot of people, since learning about the classes, find out about and register for Doula Services. They can’t believe how much value they’re getting for such an affordable price. It’s been so rewarding being there for people at such an important moment in their lives, making the whole experience easier and so full of love, instead of stress.

If you have any questions feel free to call 604 809 3288 or 778 908 7636. If you have any friends who are expecting, let them know about us so they can have an easier time too!